Increasing empathy 1

Autobiographical Memory Sharing: A Tool for Increasing Empathy

Empathy is a phenomenon evident in everyday life as people ‘feel for’ each other’s difficulties. Due to its value in promoting pro-social human interaction, empathy is considered a human virtue. It is more basically a cognitive-emotional process. Understanding the nature of empathy, and when it is likely to be elicited, has wide-reaching applications for formal and informal care-giving for elders and people of all ages.Particularly considering the prevalence of chronic pain in an aging population, an understanding of how age affects empathy is needed.

One area in which empathy has been theorized about, but little investigated, is that of autobiographical memory. Autobiographical memory (AM) may be one of the necessary human capacities that allow empathy. That is, lacking any precise or objective way to gauge how another person is experiencing pain or distress, autobiographical memories of one’s own similar or relevant experiences provide a basis to judge how a situation may feel to another individual. Theoretical work suggests that empathy elicitation is one of the social functions served by AM (Alea & Bluck, 2003; Conway, 1996), but few empirical studies have investigated this claim (for one study, see Pohl, Bender, & Lachmann, 2005).

To examine this idea, the current study assesses whether individuals feel increased empathy for people they perceive are in chronic pain when they share their own pain memory. The study particularly examines whether individuals feel less empathy for older adults in chronic pain in comparison to younger adults in the same amount of pain, and whether such differences persist even after sharing a personal pain-related AM. It is expected that individuals may feel less empathy for older adults as a result of the popular, though potentially ageist view that it is normative for older adults to experience chronic pain.

Conceptualization of Empathy

The English word empathy is a translation of its German equivalent, ‘Einfühlung,’ which literally means ‘feeling into’ (Hoffman, 1984). But what does the process of ‘feeling into’ the cognitive and emotional landscape of another entail? Currently, although debated across the subdisciplines of psychology, the theory of empathy as a cognitive-emotional process is the most inclusive. This view is based on the assumption that empathy relies on the interplay between cognitive and affective components (Davis, 1983), thereby combining views of researchers who focus on empathy as either a solely cognitive or solely emotional process. A closer inspection of these earlier views illustrates how the current cognitive-emotional view of empathy developed.

The cognitive perspective of empathy can be traced to Kant (1788/1949) who proposed that emotion plays little role in the formation of moral principles and behaviors affected by these principles. He believed the development of moral principles to be influenced only by rational processes. Carl Rogers added to the cognitive conception of empathy through his definition, “to perceive the internal frame of reference of another person with accuracy and with emotional components and meanings which pertain thereto as if one were the person, but without losing the as if condition” (Rogers, 1959, p. 210). This definition highlights the perspective-taking that is viewed as fundamental to a cognitive view of empathy.

Contrary to the cognitive view, original conceptions of empathy as an affective process suggest it involves sharing the emotional experience of another (Hume, 1777/1966). Keefe (1976) argued that empathy may have cognitive components but also involves the capacity for emotional response. One must intend to respond with compassion to the distress of another person. This view of empathy stresses the ability to affectively experience the state another is in as opposed to only taking the other’s perspective.

The integration of the cognitive and affective views of empathy is a more recent trend. Although researchers investigating empathy have created their own idiosyncratic definitions, many psychologists (e.g.Eisenberg, 2000; Ickes, 2003) consider the following components fundamental (Decety & Jackson, 2004): (a) an affective response to another person; (b) the cognitive ability to take the perspective of the other person; (c) a regulatory mechanism to monitor the roots of self- and other-feelings. While this definition is reasonable, it does not explain how one individual is able to take another’s perspective or share their affective experience. Ickes (1997, p. 2) illuminates the necessary mechanisms for experiencing empathy, stating it is a “complex psychological inference in which observation, memory, knowledge, and reasoning are combined to yield insights into the thoughts and feelings of others.” Note that this definition identifies a link between empathy and AM by identifying memory as one crucial mechanisms that creates empathy.

Research by Robinson and Swanson (1990) suggests more specifically how memory may operate in the process of experiencing empathy. They suggest that people convert their experiences into easy to recall representations that are used to help make predictions about the world, including how others may feel. Thus, symbolically representing past experience in memory allows individuals to infer and predict others’ feeling states. When another individual is perceived as in distress or pain, representations of one’s own pain experiences may be brought to mind, and empathy may be triggered. In sum, empathy is best conceptualized as a cognitive-emotional process. Elicitation of empathy relies, among other things, on using one’s personal memory to form inferences about what others may be experiencing.

Measurement of Empathy

Researchers who design instruments to assess empathy must account for the multidimensional nature of the construct while considering practical methodological issues. Most studies of empathy currently use validated self-report inventories (Stepien & Baernstein, 2006). One limitation in measuring empathy is the low reliability and validity of empathy measures, which are likely impacted by the social desirability bias (Langevin et al., 1999). Davis’ Interpersonal Reactivity Index appears, however, to be the most commonly used and accepted scale in the literature. The four subscales include (a) Perspective-taking, (b) Empathic Concern, (c) Empathy Fantasy, and (d) Personal Distress. Studies show this scale has a high test-retest reliability (r = .62 to .71), good external validity, and reasonable internal consistency (Cronbach’s α = .56 to 0.75; Lamsfuss, Silbereisen, & Böhnke, 1990). Due to its self-report nature, we suggest that, used in combination with a measure of social desirability, this appears to be a reasonable multi-dimensional measure of empathy.

Some consensus has been reached concerning the conceptualization of empathy, and several measurement approaches have been fruitfully employed in the literature. The conditions under which a person is likely to feel empathy, however, have been investigated less commonly. Particularly, the role of AM sharing in increasing empathy has not been investigated. Autobiographical memory researchers have theorized that memory sharing may increase feelings of empathy in people who are responding to others in pain or distress. A brief review of the functional approach to AM elaborates how this might operate.

The Social Function of Autobiographical Memory

Traditionally, work on AM has centered on memory accuracy and performance. Alternatively, the functional approach to AM (Bluck & Alea, 2002; Neisser, 1978; Pillemer, 1992) focuses on what individuals use autobiographical memory for in everyday life, that is, what functions it serves (Bruce, 1989; Neisser, 1978). Based on previous theory, Bluck and Alea (2002) have categorized the functions of AM into three broad areas including a self, directive and social function (Cohen, 1998). While previous research has examined the self function (Bluck & Alea, in press) and the directive function (Bluck & Glück, 2004), the current study, with empathy as its central construct, focuses on the social function. A recent conceptual model of the social functions of AM, while not exhaustive (Alea & Bluck, 2003), delineates some of the factors that might affect when AM is likely to serve social functions.

According to Alea and Bluck’s model (2003), personally meaningful autobiographical memories (Bluck & Habermas, 2001; Conway, 1996) can be seen as serving three important social functions: (a) the development and maintenance of intimacy in relationships, (b) teaching and informing others, and (c) eliciting and expressing empathy. The elicitation of empathy refers specifically to the idea that the process of sharing autobiographical memories may elicit an empathic response if the speaker’s memory engages the listener, and the listener responds with an AM that relates to the experience of the speaker (Pillemer 1992).

The model proposes that several factors can influence how well social functions of AM are served in a given memory sharing situation. For example, the degree to which social functions of AM (e.g., empathy) are served can depend on factors such as characteristics of both the speaker and the listener (e.g., age, gender, personality). The current study attempts to fill a void in the literature by empirically assessing whether AM sharing results in greater empathy towards a person who is perceived to be in chronic pain. Based on the conceptual model just described, the age of the target person in pain will be varied to assess whether AM serves an empathy function differentially when the target person is perceived to be an older versus a younger adult suffering from chronic pain.

Eliciting Empathy for Individuals in Chronic Pain

Chronic pain is an issue that affects between 5 and 7 percent of the general population. Although many people assume pain is tied to physiological damage, chronic pain can be the result of multiple factors that are physical, psychological, social, and cultural (Frischenschlager & Pucher, 2002). The uniqueness of the causes of pain across individuals partially explains why an individual’s experience of pain is difficult to objectively measure. The current methods of assessing pain in the medical and helping professions rely on verbal descriptions from the patient, the patient’s nonverbal expressions, and subjective assessments from caregivers (Frischenschlager & Pucher, 2002). When medical professionals question caregivers about the pain they believe the patient is in, empathic caregivers are more likely to characterize the nature of the patient’s pain accurately (Strayer & Roberts, 1989). Empathy opens the door for effective communication between patient and caregiver by coordinating their thoughts and feelings thereby promoting increased exchange of information (Goldstein & Michaels, 1986).

Aside from improving dyadic communication, empathy can provide a powerful motivator for the caregiver to deliver the best care possible. According to a recent model of care-giving by Schultz et al. (2007), the recognition of patient suffering, which depends in large part on empathy, is essential for the development of compassion for the patient or a loved one. Implicit in the definition of compassion is a motivational component. As well as feeling concern and distress that someone of value to the caregiver is suffering, when feeling compassion the caregiver will also feel a strong motivation to relieve that person’s suffering. Thus, empathy leads to compassion, which motivates actions to relieve the suffering of the other.

Empathy can be used to promote communication between caregivers and those in pain, and increase the likelihood that those people receive the best care possible to relieve suffering. As such, the conditions under which empathy can be increased are an important research focus. If AM can be used to increase empathy, this technique could be employed in the training curriculum for medical and helping professions as well as in community outreach programs to enhance communications between patients, and formal and informal care providers.

Old and In Pain

People may be less likely to empathize with another if they focus on the person not simply as a person but as an old person. This is especially relevant considering that the presence of acute and chronic pain is more common in older people. Many older adults in chronic pain face the ageist view that pain is a normative aspect of ageing (Gagliese & Melzack, 1997). Existing work has shown that medical professional often ascribe symptoms reported by older people to their age rather than to the condition causing the symptoms, which may be treatable (Lasser et al., 1998). This error may lead family members, caregivers, and professionals to accept pain occurring among older people that would be unacceptable in younger people and to show less empathy, and potentially take less action, as a result. Understanding whether empathy is based partially on age has clear implications in medical and care-giving settings where professionals deal constantly with older adults in pain.

The Current Study: Hypotheses

The current study investigates the role of autobiographical memory sharing in increasing empathy toward young and older people in chronic pain. Measures assess participants’ empathy levels after reading a standard narrative written by a person in chronic pain (pretest) and then again (posttest) after assignment to one of two conditions. Conditions involve either sharing an AM of having themselves been in pain (self-memory rehearsal) or, in the control condition, thinking aloud about the person in pain by recalling as much of the pain narrative as possible (other-memory rehearsal). Perceived age (25 years old, 85 years old) of the narrative’s author is varied systematically across these conditions. The hypotheses are as follows: (1) Pretest ratings of empathy will be higher in participants who believe that the pain narrative was written by a 25 year old than those who believe it was written by an 85 year old. (2) If differences in empathy are found at pretest, such that participants feel greater empathy for the young narrator than the old narrator, differences are expected to disappear at the posttest in the self-memory rehearsal condition but not in the other-memory rehearsal condition. (3) Regardless of Narrator’s Age condition, participants in the self-memory rehearsal condition will show a significant increase in empathy from pretest to posttest compared to participants in the comparison condition (other-memory rehearsal).

Method

Design

This study is a 2 Memory Rehearsal Type (self-memory rehearsal, other-memory rehearsal) X 2 Narrator’s Age (25 years old, 85 years old) X 2 Participant Gender (male, female) repeated measures design. Memory Rehearsal Type, Narrator’s Age, and Participant Gender are between subjects variables. Time (pretest, posttest) is a within subject, repeated measures variable. The completion of this study required the development of an ecologically valid (Neisser, 1986) pain narrative.

Pain Narrative Development

The pain narrative used for this study was developed with concern for validity. A review of the pain literature suggested that there are three components considered fundamental in the assessment of chronic pain, including pain severity, interference with life, and negative mood (De Raedt et al., 2002; Melzack, & Katz, 2001). These components are commonly measured using the West Haven-Yale Multidimensional Pain Inventory (Kerns, Turk, & Rudy, 1985).

The initial draft of the pain narrative was created by combining several journal entries of a woman in chronic pain to describe a typical morning. This draft was then modified to clearly encompass the three dimensions of chronic pain as revealed by a review of the pain literature. The goal was to create an ecologically valid account of how a person suffering from chronic pain might tell about a day in which he or she experienced a moderate level of pain. The final draft was two pages long and was put into a booklet with a cover page giving the age of the fictitious narrator without revealing the narrator’s gender or ethnicity. The cover page and the narrative both make reference to the age of the narrator so that the participant believes that either a 25 year old or 85 year old person wrote the narrative.

Participants

The participants in this study (N = 80) were undergraduate students solicited from the Psychology Subject Pool. Each participant received course credit as compensation for participation. Ten pilot study participants completed the protocol before official data collection began. Participants were randomly assigned to one of two Memory Rehearsal Type conditions that were balanced by gender. Participants ranged from 18-25 years old (M = 19.28). The breakdown of ethnicities included 57.7% Caucasian, 15.4% Hispanic, 12.8% African American, 7.7% Asian/Pacific Islander, and 6.4% “other”.

To ensure that the participants had previous experience with pain and could thereby share an autobiographical memory, the Personal Pain History questionnaire was administered (modified version of Part 1 of the West Haven-Yale Multidimensional Pain Inventory; Kerns, Turk, & Rudy, 1985). Ratings showed participants had experienced moderate amounts of pain in terms of: Severity (M = 4.03, SD = 1.67), Negative Mood (M = 2.95, SD = 1.38), and Interference with Life (M = 2.65, SD = 1.46).

Since the study also measures participants’ empathic responses to young and old individuals, a measure of ageism was included to assess participants’ overall attitudes. Participants completed the Aging Semantic Differential Scale (Rosencranz & McNevin, 1969) in response to both a young and an old target person. Higher scores indicate a more negative view of the target person. A repeated measures ANOVA for each subscales was performed with Target Person (young person, old person) as the within subjects variable. Older people were rated as less instrumental/more ineffective (M = 5.05, SD = .69) than young people (M = 2.65, SD = .57), F (1, 74)= 452.68, p < .001, MSE = .47, η2p = .86, and as less personally acceptable (M = 3.55, SD = .94) than younger people (M = 3.21, SD = .59), F (1, 74)= 7.57, p < .01, MSE = .59, η2p = .09. In spite of this, however, participants rated older people (M = 3.12, SD = .88) as more autonomous/less dependent than young people (M = 3.81, SD = .75), F (1, 74)= 22.84, p < .001, MSE = .87, η2p = .24, and also viewed older people (M = 2.59, SD = 1.06) as more empathic/less apathetic than younger people (M = 3.52, SD = .80), F (1, 74)= 40.25, p < .001, MSE = .84, η2p = .37.

Measures

All measures used in the study are described below in the order they were administered.

Demographics. Participants were asked to self report demographic information (e.g. age, gender, ethnicity, overall physical and mental health) using a standard Demographics Questionnaire.

Interpersonal Reactivity Index (IRI; Davis, 1983). The IRI is a self-report measure that assesses cognitive and affective components of empathy with a 28-item questionnaire. The four subscales include Perspective-taking, Empathic Concern, Fantasy, and Personal Distress. For the purpose of this study, only the Perspective-taking subscale and the Empathic Concern subscale were used. Items are the same as in the original scale but have been altered to ensure that the participant responds concerning how they are feeling right now and in reference to the target person (i.e. the narrator).